Hot flashes: Minimize discomfort during menopause

(MayoClinic.com) Hot flashes can descend on you at any time, leaving you sweaty and red-faced. But they're quite common — as many as three out of every four women experience hot flashes as they go through the menopausal transition.

You don't need to seek treatment for hot flashes, especially if you're tolerating them well on your own. If your hot flashes are particularly bothersome, treatment options are available. But finding the best way to control your hot flashes can take time. Start by asking yourself how hot flashes are disrupting your regular life. Then consider the benefits and drawbacks of the most common remedies, which range from lifestyle changes to prescription medications.

When you're having a hot flash, you might experience:

• A feeling of mild warmth to intense heat spreading through your upper body and face
• A flushed appearance with red, blotchy skin on your face, neck and upper chest
• A rapid heartbeat
• Perspiration, mostly on the upper body
• A chilled feeling as the hot flash subsides

Hot flashes vary in frequency — you may have several a day or just a few a week. You could experience full-on sweating throughout the day and night, or you may just occasionally feel warmer than you used to. Hot flashes can last as long as 30 minutes, but most subside within a couple of minutes. Nighttime hot flashes — or night sweats — can wake you from a sound sleep.

Hot flashes are common during perimenopause — the period of time leading up to menopause — and tend to peak during the first couple of years after menstrual periods have stopped. For some women, hot flashes last up to a couple of years. For others, hot flashes may continue for several years or indefinitely.

If your hot flashes are mild — you have just a few a day, and they don't interfere with your normal activities — you may be able to manage them with lifestyle adjustments. For example:

• Keep cool. Slight increases in your body's core temperature can trigger hot flashes. Dress in layers so that you can remove clothing when you feel too warm. Open a window or use a fan or air conditioner to keep air flowing. If you feel a hot flash coming on, sip a cold drink.
• Get active. Daily exercise is important during the menopausal years. If you aren't already exercising regularly, now is the time to increase your physical activity and add regular aerobic exercise. With your doctor's OK, try brisk walking — or a similarly vigorous exercise — for 30 minutes or more on most days of the week.
• Watch what you eat and drink. Hot and spicy foods, caffeinated beverages and alcohol can trigger hot flashes. Learn to recognize your own triggers and avoid those foods or drinks that bring on hot flashes.
• Relax. Many women find relief from mild hot flashes through yoga, meditation, relaxation or other stress-reducing techniques. Even if these approaches don't quell your hot flashes, they may provide other benefits — such as easing the sleep disturbances that tend to occur with menopause.

• Practice paced respiration. Deep, slow abdominal breathing — known as paced respiration — can decrease hot flashes. It takes some practice to perfect the technique, but paced respiration done twice daily or at the beginning of a hot flash can be quite helpful.

  To practice paced respiration, begin by sitting comfortably. Breathe in deeply for five seconds, pushing your stomach muscles out. Exhale for five seconds, pulling your stomach muscles in and up. Repeat this cycle of breathing deeply in and out until you feel calm and relaxed — for 15 minutes twice daily, at the start of a hot flash, or for a minute or two in the middle of a busy day.

• Don't smoke. Smoking is linked to increased hot flashes. By not smoking, you may reduce hot flashes as well as your risk of many serious health conditions, such as heart disease, stroke and cancer.

Dietary supplements some women use to curb hot flashes include:

• Black cohosh. Black cohosh has been used widely in Europe for treating hot flashes and has been popular among women with menopausal symptoms in the United States. While its safety record has been good, there's no longer much reason to believe that it's effective for menopausal symptom relief.

  In a meticulously conducted yearlong clinical trial funded by the National Institutes of Health (NIH) and published in late 2006, black cohosh was found to be no better than placebo for relieving hot flashes. Women with hot flashes were assigned to take black cohosh alone, black cohosh in a mixed herbal supplement, hormone therapy or a placebo (inactive pill). The women given black cohosh-containing supplements reported the same number of daily hot flashes as did women given a placebo.

• Soy and red clover. Scientists have observed that women in Asian countries, where soy is a regular part of the diet, are less likely to report hot flashes and other menopausal symptoms than are women in other parts of the world. One reason might be related to isoflavones — estrogen-like compounds in soy, red clover and many other plants. However, studies giving soy to women with hot flashes have generally found no benefit. And studies giving selected isoflavones have shown mixed results for menopausal symptom relief.

  Isoflavones have some weak estrogen-like effects, so there's some concern about cancer risk. If you've had breast cancer, talk to your doctor before supplementing your diet with isoflavone pills or red clover. Experts generally consider whole foods containing soy or isoflavones to be healthy and safe, when consumed in moderation.

• Vitamin E. Studies using vitamin E in doses up to 400 international units (IU) daily have found little benefit in relieving hot flashes. Vitamin E is no longer recommended for treating hot flashes.

Take all herbal supplements with a dose of caution. Just because manufacturers claim their products are natural doesn't mean they're safe. All supplements have potentially harmful side effects — and supplements may interact with medication you're taking for other medical conditions. Always review what you're taking with your doctor.

If you continue to have troublesome hot flashes despite making lifestyle changes, your doctor may recommend hormone therapy or a different prescription medication.

Estrogen therapy is the most effective treatment for hot flashes, but in rare instances, doctors might prescribe progesterone therapy.

• Estrogen therapy. If you've had a hysterectomy, you may take estrogen alone. But if your reproductive organs are still intact, progesterone should be taken along with estrogen to protect against cancer of the lining of the uterus (endometrial cancer). With either regimen, current recommendations are to use the lowest effective dose for the shortest amount of time needed to relieve symptoms.

  It's not easy to assess whether the benefits of hormone therapy outweigh the risks in your particular situation — and the frequent revision of expert recommendations hasn't helped. For most women, short-term hormone therapy is probably less risky than they've been led to believe since 2002, when a large clinical trial of estrogen-plus-progesterone was stopped early due to higher than expected heart disease, stroke and breast cancer rates. A new analysis of data from the same trial found that heart disease risk, for example, actually was reduced for women in their 50s who started estrogen therapy within 10 years of the start of menopause. Still, one group of women — those who initiated hormone therapy more than 10 years after menopause — had increased heart disease rates according to both analyses of the trial data.

  If you experience moderate to severe hot flashes and you haven't had blood-clotting problems, breast cancer or ovarian cancer, estrogen therapy may be an option for you. Your doctor can help you weigh the pros and cons.

• Progesterone therapy. Rarely, as an alternative for women who can't take estrogen, some doctors prescribe progesterone alone to control hot flashes. Two such medications include megestrol acetate and depomedroxyprogesterone acetate, found to provide some relief from hot flashes among women with breast cancer or at increased risk of cancer.

If you decide against estrogen or progesterone therapy, your doctor may suggest a different prescription medication. There are several nonhormonal medications that can be helpful for reducing hot flashes. These medications aren't approved by the Food and Drug Administration specifically to treat hot flashes, but they are approved for treating other conditions.

• Antidepressants. Low doses of certain antidepressants may decrease hot flashes. Antidepressants from classes of medications known as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) — including venlafaxine (Effexor), paroxetine (Paxil), fluoxetine (Prozac), citalopram (Celexa) and others — have been found to relieve hot flashes in some clinical trials.

  Many doctors now consider these antidepressants the treatment of choice if you have troublesome hot flashes and can't — or choose not to — take hormone therapy. However, these medications aren't as effective as hormone therapy for severe hot flashes and may cause unwanted side effects, such as nausea, dizziness, weight gain or sexual dysfunction. Talk with your doctor about whether the benefits outweigh the potential side effects for you.

• Gabapentin. Gabapentin (Neurontin) is a medication approved for treating seizures or pain associated with shingles. It's also increasingly used to treat various other types of pain. Some studies have found that gabapentin is moderately effective in reducing hot flashes. Side effects can include drowsiness, dizziness, nausea, imbalance when walking and swelling.
• Clonidine. Clonidine, a pill or patch typically used to treat high blood pressure, may provide some relief from hot flashes. Side effects such as dizziness, drowsiness, dry mouth and constipation are common, sometimes limiting the medication's usefulness for treating hot flashes.

Menopause is a natural transition. If hot flashes don't interfere with your life, you don't need treatment. If you choose to take medication or a supplement to help ease your symptoms, periodically re-evaluate your need for continuing it. For most women, hot flashes fade gradually and require no treatment.

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